Comparison of Caudal Ropivacaine with Ketamine and Ropivacaine with Midazolam for Pediatric Infraumbilical Surgery Analgesia

Abstract

Background: Caudal epidural analgesia is a widely used regional technique for pediatric infraumbilical surgeries. To enhance the duration and quality of analgesia, adjuvants like ketamine and midazolam are frequently added to local anaesthetics such as ropivacaine. However, the optimal combination offering superior efficacy and minimal side effects remains under evaluation. Aim: To compare the analgesic efficacy and safety of caudal ropivacaine with ketamine versus ropivacaine with midazolam in children undergoing infraumbilical surgeries. Materials and Methods: A randomized double-blind study was conducted on 130 pediatric patients, aged 1-10 years, undergoing elective infraumbilical surgeries. Patients were divided into two groups: Group A (n = 65): Ropivacaine 0.2% (1 mL/kg) + ketamine 0.5 mg/kg and Group B (n = 65): Ropivacaine 0.2% (1 mL/kg) + midazolam 50 µg/kg. Postoperative pain was assessed using the FLACC scale at various intervals, and complications were recorded. Statistical analysis was done using t-test and Chi-square test. Results: Demographic variables were comparable between both groups. Group A showed significantly lower FLACC scores at 2, 4, 6, and 12 hours postoperatively (p < 0.05), indicating prolonged and superior analgesia with ketamine. The requirement of rescue analgesia was reduced in Group A. Incidence of complications such as vomiting and fever was higher in Group B, though not statistically significant. Conclusion: Caudal administration of ropivacaine with ketamine provided longer and more effective postoperative analgesia compared to ropivacaine with midazolam, with a comparable safety profile. Hence, ketamine may be considered a more effective adjuvant for caudal blocks in pediatric infraumbilical surgeries.